Jurnalul de Chirurgie
 Jurnalul de chirurgie
Aparitie trimestriala in a doua luna a trimestrului
Published quarterly in the second month of the quarter
ISSN: 1584 - 9341 Vol.10 Nr.3 - Iulie-Septembrie 2014 | miercuri, 16 octombrie 2019
ISSN: 1584 - 9341 Vol.10 No.3 - July-September 2014
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LATE DIAGNOSIS OF AN END STAGE PANCREATIC ACTH-OMA; CASE REPORT AND LITERATURE REVIEW
R. Moldovanu (1), A. Vasilescu (1), E. Târcoveanu (1) C. Lupaşcu (1), H. Mehier (2),
Felicia Crumpei (3), N. Vlad (1), Niculina Florea (4)
(1) First Surgical Clinic „I. Tănăsescu – Vl. Buţureanu” „St. Spiridon” Hospital Iaşi
University of Medicine and Pharmacy „Gr.T. Popa” Iaşi
(2) CERMA, Archamps, France
(3) Department of radiology; 4 Department of pathology, „St. Spiridon” Hospital Iaşi
Jurnalul de chirurgie 2008; 4 (3): 217-224
Full text:
Format PDF (Engleză/English)

Abstract:

Background: The management of digestive endocrine tumors is often challenging. These tumors are classified in two groups: pancreatic endocrine tumors (PEnT) and endocrine tumors from digestive tract. Methods: A 27 years old, woman was admitted in the First Surgical Clinic Iaşi for ectopic Cushing syndrome and unknown origin liver metastasis. A laparoscopic liver metastasectomy (for biopsy) and thermonecrosis of the other liver metastasis by overheated steam were performed. The histological and immune-histochemistry exams diagnosed metastasis from endocrine tumors. The biological exams revealed high levels of cortisol, ACTH and persistent hypokaliemia. Further imagery exams (CTscan, PETscan and Octreoscan) diagnosed the primary tumor in the pancreas (ACTH-oma) and other metastasis in ovaries. The patient was admitted again for upper GI hemorrhage and near-total dysphagia. The endoscopy and enteroscopy diagnosed multiples ulcers on the stomach, duodenum and jejunum, and peptic esophageal stenosis with reflux esophagitis. Other three surgical procedures have been performed: bilateral ovarectomy due to metastasis, bilateral adrenalectomy (to control the hypercortisol levels) and jejunostomy. The postoperative course was complicated by bone (vertebral) metastasis with paraplegia. The patient died after 18 months. Conclusions: PEnTs are rare tumors, and their management is always challenging. For these tumors it is necessary to recognize the clinical signs of the secreting tumors (inclusive carcinoid syndrome) and to carefully explore the patients. Unfortunately, Octreoscan and Positron Emission Tomography are not available in Romania. Aggressive surgical treatment - excision of the primary lesion and multimodality approach of the liver metastasis (resection, ablative techniques, chemotherapy) - is indicated for PEnTs, even in advanced stages. Liver transplant for non-resectable liver metastasis from PEnTs, it is also recommended in selected patients (after resection of the primary tumor).

KEY WORDS: PANCREATIC ENDOCRINE TUMORS, LIVER, METASTASIS, LAPAROSCOPY, THERMONECROSIS

Correspondence to: Radu Moldovanu, MD, PhD, First Surgical Clinic, „St. Spiridon” Hospital Iaşi, Independenţei Street, No. 1, 700111, Iaşi, Romania; e-mail:



: Creative Commons License
Jurnalul de chirurgie [Journal of Surgery] by Editorial Board, Department of Surgery University of Medicine and Pharmacy Iasi, E. Tarcoveanu, R. Moldovanu is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.
Based on a work at www.jurnaluldechirurgie.ro.